BEUDAMED
    FDA Adverse Event Death Summary report: N

    QUICKIE

    MDR report key: 360233 · Received November 19, 2001

    Report

    Report Number
    2082643-2001-00324
    Event Type
    Death
    Date Received
    November 19, 2001
    Date of Event
    January 23, 2001
    Report Date
    November 16, 2001
    Manufacturer
    SUNRISE MEDICAL, MPD
    Product Code
    IOR
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    REPORTER STATES THAT IN 2001, END USER WAS BEING TRANSPORTED HOME FROM SCHOOL, BY THE FACILITY. THEY PUT END USER ON THE LIFT WITHOUT RECLINING THE CHAIR OR PUTTING THE PIN IN PLACE, AS A RESULT, THE CHAIR TIPPED FORWARD AND END USER FELL TO THE GROUND HITTING THE HEAD. END USER DEVELOPED A HEMATOMA AND DIED 5 DAYS LATER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    52200 QUICKIE WHEELCHAIR, MECHANICAL IOR SUNRISE MEDICAL, MPD ZIPPIE P/N EITS

    Patients

    Seq Age Sex Outcome Treatment
    1 6 YR Death